AB0384 THE EFFECT OF A LIFESTYLE PROGRAM ON PATIENTS AT RISK FOR RHEUMATOID ARTHRITIS:THE “PLANTS FOR JOINTS” PILOT RANDOMIZED CLINICAL TRIAL
Authors: C. Wagenaar, W. Walrabenstein, M. van der Leeden, F. Turkstra, J. Twisk, M. Boers, H. van Middendorp, P. Weijs, D. van Schaardenburg
Journal: Annals of the Rheumatic Diseases (2022)

Background An unhealthy lifestyle increases the risk of developing rheumatoid arthritis (RA). Interventions including plant-based diets, physical activity, and stress management have shown benefits for RA patients but have not yet been evaluated in a program for patients at risk for RA. Objectives To investigate preliminary effectiveness of a multidisciplinary lifestyle program on RA risk in patients at risk for RA, in comparison to usual care. Methods In the “Plants for Joints” (PFJ) pilot RCT, patients with anti-citrullinated protein antibody (ACPA) positive arthralgia were randomized to the PFJ or control group. Both groups received usual care while the PFJ group additionally followed a 16-week lifestyle program based on a whole food plant-based diet, physical activity, and stress management. 1 The primary outcome was risk of developing RA as quantified by the RA risk score (including family history, symmetry, stiffness, pain level, RF/ACPA level). 2 The maximum score (13 points) was given to participants who developed RA. Secondary outcomes included self-reported pain intensity, inflammatory, anthropometric, and metabolic markers, and serum levels of ACPA and rheumatoid factor (RF). A linear mixed model for between group analysis was used, adjusted for baseline values. Results 14 out of 17 included patients completed the study (all female, mean age 47 years). Three patients ( n = 2 PFJ group, n = 1 control group) were diagnosed with RA after mean 9.6 weeks and remained in the study. After 16 weeks there was no significant difference in RA risk score between PFJ and control groups (Figure 1). Compared to the control group, the PFJ group had significantly lower fat mass and LDL-cholesterol after 16 weeks (Table 1). After the intervention the PFJ group had an average weight loss of 4.9 kg, of which 2.7 kg was fat mass. Table 1. Results reported as mean (SD) when normally distributed and median [Q1 – Q3] when skewed. P -value &lt;0.05 = significant. RA = rheumatoid arthritis, ACPA = anti-citrullinated protein antibody, RF = Rheumatoid factor, ESR = erythrocyte sedimentation rate, CRP = C-reactive protein. Plants for Joints group ( n = 7) Control group ( n = 7) Baseline Week 16 Baseline Week 16 p -value RA risk and related outcomes RA risk score 6.1 (1.4) 8.6 (3.4) 7.1 (1.4) 8.3 (2.3) 0.56 Pain intensity 4.9 (2.6) 3.8 (1.9) 5.7 (2.6) 4.0 (2.1) 0.74 ACPA, kU/l 330 [94 - 530] 225 [116 - 550] 256 [79 - 462] 202 [94 - 403] 0.86 RF, kU/l 13 [3 - 68] 11 [3 - 56] 12 [3 - 21] 5 [4 - 12] 0.96 RA diagnosis, N 0 2 0 1 - Inflammation ESR, mmol/hour 9 [6 - 15] 7 [6 - 9] 7 [6 - 12] 12 [8 -17] 0.79 CRP, mg/l 0.7 [0.6 - 2.5] 0.6 [0.6 - 1.2] 3.0 [1.1 - 3.6] 3.3 [1.3 - 6.7] 0.58 Anthropometric Weight, kg 78.4 (18.6) 73.5 (16.4) 77.4 (16.2) 77.0 (16.3) 0.28 BMI, kgm -2 26.8 (5.3) 25.1 (4.5) 28.2 (6.2) 28.0 (6.0) 0.23 Fat mass, kg 30.6 (14.3) 27.9 (12.3) 31.2 (12.8) 29.8 (13.0) &lt;0.01 Waist circumference, cm 87.9 (13.3) 86.6 (11.6) 91.6 (15.5) 90.6 (16.1) 0.33 Metabolic LDL-cholesterol, mmol/l 3.1 (0.87) 2.83 (0.75) 3.07 (0.36) 3.05 (0.36) &lt;0.01 HbA1C, mmol/mol 34.9 (3.2) 34.4 (3.1) 35.1 (3.0) 36.9 (3.6) 0.97 Conclusion The results of this pilot study do not suggest the PFJ lifestyle program influenced RA risk score, pain, or autoantibody levels, although possible effects cannot be excluded due to the small sample size. However, metabolic health clearly improved in the PFJ group. References [1]Walrabenstein, Trials 2021 [2]van de Stadt, Ann Rheum Dis 2013 Acknowledgements C. W. was funded by ZonMW (The Netherlands Organization for Health Research and Development) grant number 555003210. Disclosure of Interests Carlijn Wagenaar: None declared, Wendy Walrabenstein: None declared, Marieke van der Leeden: None declared, Franktien Turkstra: None declared, Jos Twisk: None declared, Maarten Boers Consultant of: Consultant for Novartis, Henriët van Middendorp: None declared, Peter Weijs: None declared, Dirkjan van Schaardenburg: None declared